Provider Demographics
NPI:1679639488
Name:DANNETT, WENDY E (MSW)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:E
Last Name:DANNETT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MEDICAL PARK DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970
Mailing Address - Country:US
Mailing Address - Phone:845-354-5111
Mailing Address - Fax:845-354-5111
Practice Address - Street 1:11 MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970
Practice Address - Country:US
Practice Address - Phone:845-354-5111
Practice Address - Fax:845-354-5111
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0163951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR5061OtherOXFORD
NY0099168OtherGHI
NMR5061OtherOXFORD